泰国新冠疫情之前和期间院外心脏骤停的紧急医疗服务反应及结果比较：一项横断面研究
The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study.
作者信息
Huabbangyang Thongpitak, Klaiangthong Rossakorn, Silakoon Agasak, Sretimongkol Suttida, Sangpakdee Sutasinee, Khiaolueang Manit, Seancha Pattama, Nuansamlee Tontrakan, Kamsom Anucha, Chaisorn Ratree
机构信息
Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand.
Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
出版信息
Int J Emerg Med. 2023 Feb 20;16(1):9. doi: 10.1186/s12245-023-00489-x.
BACKGROUND
During the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand.
METHODS
This retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018-December 31, 2019, and January 1, 2020-December 31, 2021, respectively.
RESULTS
A total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =- 6.0, 95% confidence interval [CI] - 4.1, - 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36-8.27; p value < 0.001), and 6.88 min (95% CI 4.55-9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50-3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58-1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic.
CONCLUSIONS
In the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.
背景
在2019年冠状病毒病（COVID-19）大流行期间，院外心脏骤停（OHCA）患者的管理模式发生了改变。因此，本研究比较了泰国在COVID-19大流行之前和期间，由紧急医疗服务（EMS）管理的OHCA患者的反应时间和现场生存率。
方法
这项回顾性观察研究使用EMS患者护理报告，收集编码为心脏骤停的成年OHCA患者的数据。COVID-19大流行之前和期间分别定义为2018年1月1日至2019年12月31日以及2020年1月1日至2021年12月31日。
结果
分别有513例和482例患者在COVID-19大流行之前和期间接受了OHCA治疗，显示减少了6%（变化百分比差异=-6.0，95%置信区间[CI]-4.1，-8.5）。然而，每周治疗的患者平均数量没有差异（4.83±2.49对4.65±2.06；p值=0.700）。虽然平均反应时间没有显著差异（11.87±6.31对12.21±6.50分钟；p值=0.400），但与大流行之前相比，COVID-19大流行期间的平均现场时间和医院到达时间显著更长，分别长6.32分钟（95%CI 4.36-8.27；p值<0.001）和6.88分钟（95%CI 4.55-9.22；p值<0.001）。多变量分析显示，与大流行之前相比，COVID-19大流行期间OHCA患者的自主循环恢复（ROSC）率高出2.27倍（调整后的优势比=2.27，95%CI 1.50-3.42，p值<0.001），死亡率低0.84倍（调整后的优势比=0.84，95%CI：0.58-1.22，p值=0.36）。
结论
在本研究中，COVID-19大流行之前和期间由EMS管理的OHCA患者的反应时间没有显著差异；然而，与大流行之前相比，COVID-19大流行期间观察到现场时间和医院到达时间明显更长，ROSC率更高。
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